Telemedicine - Friendship Hospital for Animals

Important! Telemedicine can only be practiced where there is an existing client/patient relationship. Telemedicine consultations are not appropriate for many problems, no physical examination or diagnostics can be performed to guide recommendations, delays in treatment for urgent problems could result.

The telemedicine provider may recommend your pet be seen at Friendship on an appointment or urgent care basis.

Telemedicine Patient History

Step 1 of 3

Client & Patient Information
Client Name*
First Last
Please use the first and last name of the primary account holder.
Phone*
As listed in your pet's medical record.
Email*

As listed in your pet's medical record.
Patient Name*
Have you been to Friendship before with this patient?*
New Clients/Patients
To be eligible for a Telemedicine consult your pet must have a standing Veterinary-Client-Patient-Relationship with Friendship. This means your pet must have had a physical exam performed by a Friendship doctor within the last year.

Give us a call at 202.363.7300 to set up an in person exam for your pet.

Does your pet receive care from another veterinarian with whom we should share medical records?
- No
- Yes
Please provide the name of the veterinarian and/or veterinary facility.*
Would you like to upload records from another veterinarian?
- No
- Yes
File Upload
Drop files here or
Diet & Medication
Please list all food, treats, snacks and other foods your pet is currently eating, including brands and amounts (Click the + icon to add an additional line.):
Brand Formula/Flavor Amount Frequency
Is your pet's diet grain free or does it include any exotic ingredients?
- Yes
- No
What brand of heartworm prevention does your pet receive?
Other
What brand of flea/tick control does your pet receive?
Other
Please list all medications your pet is receiving including dose, strength, form, and frequency (Click the + icon to add an additional line.):
Name Dose/Strength Frequency
Please list all supplements, such as vitamins, glucosamine, fatty acids, nutraceutical or herbal treatments (Click the + icon to add an additional line.):
Name Dose/Strength Frequency

Visit Information
We are currently seeing TeleTails appointments between the hours of 7:30am—9:00am.
First Choice Date*
Date Format: MM slash DD slash YYYY
Time*
- 7:30am—9am
Please select your preferred time frame.
Second Choice Date*
Date Format: MM slash DD slash YYYY
Time*
- 7:30am—9am
Please select your preferred time frame.
Reason for Scheduling*
What would you like the doctor to know?
Images
Drop files here or
Would you like to upload any images?
Are you interested in an annual wellness plan?*
Annual wellness plans include age-appropriate veterinary care such as exams, vaccinations, lab work, and parasite screening, for one discounted fee. Please click on Wellness Plans in the left sidebar for more information.
Please choose a plan.*
If unsure, your veterinarian can help you choose a plan that fits the needs of you and your pet.

Brand	Formula/Flavor	Amount	Frequency

Name	Dose/Strength	Frequency

Name	Dose/Strength	Frequency

Pet Owners

Telemedicine Patient History

Step 1 of 3

Client & Patient Information

New Clients/Patients

Diet & Medication

Visit Information